Association between concomitant traumatic brain injury and unfavorable 1-year outcomes in patients with traumatic spinal cord injury.

OBJECTIVE

Traumatic spinal cord injury (tSCI) can cause lasting functional impairment. Concomitant traumatic brain injury (cTBI) is a common injury constellation, but the impact of tandem traumatic brain injury (TBI) and tSCI on long-term patient outcomes requires further study. The objective of this study was to compare outcomes among tSCI patients with and without TBI.

METHODS

Patients with tSCI were identified from the Spinal Cord Injury Model System (SCIMS) database. Patients with cTBI and tSCI were 1:1 propensity score matched to those with tSCI only on demographic and injury characteristics. TBI severity was stratified in the SCIMS as mild (loss of consciousness [LOC] < 30 minutes), moderate (LOC 31 minutes to 24 hours), or severe (LOC > 24 hours). Multivariable linear and logistic regression models were specified to assess relationships between cTBI severity and 1-year follow-up outcome metrics including rehospitalization, functional recovery, and quality of life (QOL).

RESULTS

Among the 1442 patients included (median age 36 [IQR 24-52] years), 44% (n = 636) presented with cTBI. After propensity score matching, 601 patients with cTBI were compared to 601 with tSCI only. Patients with cTBI had increased rehospitalization rates, reduced functional Craig Handicap Assessment and Reporting Technique mobility and occupational scores, and increased pain severity at 1-year follow-up (all p < 0.05). Additionally, patients with severe cTBI specifically exhibited significantly lower functional independence measure (FIM) scores, Satisfaction with Life Scale scores, and a higher incidence of new-onset depression (all p < 0.05) compared to those without cTBI. Multivariable analyses confirmed that moderate and severe cTBI were independently associated with worse outcomes across 8 of 10 assessed metrics, including increased rehospitalization, new-onset depression, lower FIM scores, and greater pain severity (all p < 0.05).

CONCLUSIONS

Patients with tSCI and cTBI experience worse functional outcomes and have reduced QOL 1 year after injury. Targeted rehabilitation programs could benefit patients with cTBI in the setting of tSCI.